Summers in Suspension

Last year at this time we were waiting for the final meaningful use recommendations from the policy committee. Even then (a year in HIT time seems like 10) we felt the pressure of the looming deadlines for achieving meaningful use. This summer, we’re waiting to see what the final rules look like. Depending on your point of view, they were either scheduled or promised for release by late spring, 2010. Now spring has passed, and even the government websites are have added “early summer” to the possible delivery date. Even when we do have the final rules, every product still needs to be certified, or re-certified, and we still don’t know who will be doing the certification. But worrying about all of that can ruin your summer, so instead I’ve been thinking about the concept of trust, and how much of what we envision as a result of HIT involves trust.

For example:

  • Physicians and patients might ask: Does the software work as promised? Are there any hidden problems that could jeopardize safety?
  • The government might ask: Are the end users acting in good faith? Are they using the system? Using it as designed? Or are they implementing workarounds?
  • Everyone is asking: Will the meaningful use rules increase the chances that most providers can achieve them?
  • Providers wonder: Will the government pay the incentives or look for ways to save?
  • Everyone asks: Are the systems secure?
  • Patients in particular wonder: What will employers and payers do with the data they have?
  • There are others…

We must also trust ourselves to adapt. It’s interesting that for years, the healthcare community has been aware of the fact that it is way behind in the adoption of technology to improve safety and delivery. The number one issue in just about every poll ever taken on the issue declared that the cost of these systems was the limiting factor. After all, technology is expensive. Now, the government is putting some money into softening the blow of the cost; that’s good! But that positive move has been dampened by the apparent rush to move everyone along at the same speed.

In project management, it is often said that of the three interlocking components (cheap, fast and good), you can only have two. A single implementation at one hospital is a complex undertaking; now multiply that times 5,000 hospitals in the US, factor in the half-million or so physicians who may or may not participate, and then tie it all together with the promise of one interoperable, trustworthy system. Do we trust ourselves, as a sector, to make the right choice? Which will we give up: Cheap, Fast, or Good? While the US is making a net investment in EHRs of about $17 billion (the actual initial investment is $30+ billion), consider that there are individual hospitals that have already spent hundreds of millions of dollars to get where they are today.

It’s great that we’re finally moving forward. But by making “meaningful use” the centerpiece of getting the incentive payments, the focus shifts to the money and to individual provider survival, not to the patient or to an improved healthcare system and in turn, societal benefit. This disconnect puts the larger goals in peril and, if we really care about them, we can either “trust” that someone out there is working on them, or start talking about it now. Your comments are welcomed…

-Rod Piechowski

Copyright © 2010, Rod Piechowski, Inc., Consulting

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